An Intramyocardial Lipoma Mimicking Post-infarction Fatty Changes: Discussion of Key Distinguishing Imaging Findings and Clinical Implications.

Cardiac lipomas are benign primary cardiac tumors that are most often asymptomatic and diagnosed incidentally. Cardiac magnetic resonance imaging (MRI) is the imaging modality of choice when aiming to characterize these tumors. A minority of cardiac lipomas are intramyocardial, which, when combined with the much more common post-infarction fatty metaplasia, makes diagnosing these lipomas very challenging.

What is the relative risk of urologic malignancy in microscopic hematuria patients after negative evaluation? A long-term population-based retrospective analysis of 8465 patients.

Objective: To evaluate whether microscopic hematuria (MH) patients with a negative initial evaluation have an elevated risk for urinary carcinoma.

Methods: This is a population-based retrospective study with a matched control identified 8465 adults with an MH ICD code, an initial negative urinary malignancy work-up of cystoscopy and CT urography, and at least 35 months of clinical care. 8465 hematuria naïve controls were age, gender, and smoking status matched.

Prospective evaluation of the prevalence of non-alcoholic fatty liver disease and steatohepatitis in a large middle-aged US cohort.

Background & Aims: Large prospective studies to establish the prevalence of non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH), are lacking. We prospectively assessed the prevalence and severity of NAFLD/NASH in a cohort of asymptomatic middle-aged Americans attending a colonoscopy class at a gastroenterology clinic.

Methods: Screening for NAFLD was performed using magnetic resonance (MR)-based LiverMultiScan® proton density fat fraction (LMS-PDFF).

Technical success rate of MR elastography in a population without known liver disease.

Purpose: MR elastography (MRE) has a low technical failure rate in patients with chronic liver disease. The failure rate in an unscreened population is unknown. The purpose of this study was to determine the technical failure rate of MRE in patients with no known liver disease.

The many faces of cirrhosis.

There are many different imaging features of cirrhosis, some of which are less commonly recognized. It is important that the radiologist is familiar with these features as cirrhosis can be first discovered on imaging performed for other indications, thus alerting the clinician for the need to screen for complications of cirrhosis and referral for potential treatment. This article reviews the various imaging findings of cirrhosis seen on cross-sectional imaging of the abdomen and pelvis.

Incidental Renal Lesions on Lumbar Spine MRI: Who Needs Follow-Up?

Objective: Incidentally discovered renal lesions on lumbar spine MRI are a common occurrence. Many follow-up recommendations are generated by radiologists encountering renal lesions to help characterize the finding as a benign cyst or a more complex, potentially malignant lesion. We hypothesized that analysis of T2-weighted imaging features of incidentally discovered renal lesions could reliably distinguish complex renal lesions from simple cysts.

MRI for Pediatric Appendicitis in an Adult-Focused General Hospital: A Clinical Effectiveness Study-Challenges and Lessons Learned.

Objective: The objective of our study was to determine the feasibility and accuracy of MRI for pediatric appendicitis in an adult-predominant general hospital setting where non-pediatric-trained radiologists routinely interpret the studies.

Materials And Methods: MRI was performed in pediatric patients with equivocal ultrasound (US) findings and persistent clinical concern for appendicitis. Neither IV contrast material nor a sedative was administered.

Effects of adenosine and regadenoson on hemodynamics measured using cardiovascular magnetic resonance imaging.

Background: Adenosine or regadenoson vasodilator stress cardiovascular magnetic resonance (CMR) is an effective non-invasive strategy for evaluating symptomatic coronary artery disease. Vasodilator injection typically precedes ventricular functional sequences to efficiently reduce overall scanning times, though the effects of vasodilators on CMR-derived ventricular volumes and function are unknown.

Methods: We prospectively enrolled 25 healthy subjects to undergo consecutive adenosine and regadenoson administration.

Mature Cystic Teratoma: AIRP Best Cases in Radiologic-Pathologic Correlation.

Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year.

Dual-energy Computed Tomography for the Evaluation of Enhancement of Pulmonary Nodules≤3 cm in Size.

Purpose: The aim of the study was to compare the accuracies of 4 different methods of assessing pulmonary nodule enhancement to distinguish benign from malignant solid pulmonary nodules using nondynamic contrast-enhanced dual-energy computed tomography.

Materials And Methods: Seventy-two patients (mean age, 62 y) underwent dual-energy chest computed tomography 3 minutes after intravenous contrast administration. Each of 118 pulmonary nodules (9±5.

Mild asymptomatic intrahepatic biliary dilation after cholecystectomy, a common incidental variant.

Objective: The purpose of this study is to evaluate the prevalence of intra- and extrahepatic ductal dilatation in asymptomatic individuals after cholecystectomy.

Methods And Materials: This IRB-approved retrospective cohort study evaluated the prevalence of intra- and extrahepatic biliary dilation in 77 consecutive post cholecystectomy patients who had CT obtained in the portal venous phase. These were then compared to age and sex matched control patients.

Effect of Low-Osmolar Intravenous Contrast on Renal Length.

Objective: The purpose was to study the effect of low-osmolar nonionic contrast on renal length.

Material And Methods: This study included 56 patients (4-phase renal computed tomography [CT] and 4-phase CT urogram [CTU], 19 patients each; split-phase CTU, 18 patients). Three radiologists created the best off-axis plane and renal lengths measured on a postprocessing workstation.

Multiplanar Reformations in the Measurement of Renal Length on CT: Is It Plain Which Plane to Use?

Objective: The objective of this study was to determine the accuracy of renal measurement on CT in multiple imaging planes.

Materials And Methods: In this study, three board-certified radiologists retrospectively measured 110 kidneys on CT in 55 consecutive patients. Five measurement methods were used: axial, coronal single image, coronal multiimage, sagittal single image, and sagittal multiimage.

Review of Commonly Used Serum Tumor Markers and Their Relevance for Image Interpretation.

Serum tumor markers are firmly entrenched as one of the primary tools in an oncologist's armamentarium. They can be implemented in a broad range of applications from diagnostic assistance, assessing prognosis, or guiding therapeutic decisions. However, tumor markers also have limitations, which significantly impact how they should be used.

Can a T2 hyperintense rim sign differentiate uterine leiomyomas from other solid adnexal masses?

Purpose: To investigate the incidence of high T2 signal rims surrounding leiomyomas, evaluate if a particular T2-weighted sequence is more effective in depicting this rim, and determine if this sign is useful in differentiating pedunculated leiomyomas from other solid adnexal masses.

Materials And Methods: In this retrospective study, two radiologists evaluated 233 T2 dark pelvic masses (223 uterine leiomyomas and 10 ovarian fibromas) in 60 women (mean age 47) on Magnetic resonance imaging for the presence of a high signal rim. Three different T2-weighted sequences were reviewed independently for uterine leiomyomas: half-Fourier acquisition single-shot turbo spin echo (HASTE), SPACE, and T2 with fat saturation (T2 FS).

Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know.

Surgical resection of colorectal metastatic disease has increased as surgeons have adopted a more aggressive ideology. Current exclusion criteria are patients for whom a negative resection margin is not feasible or a future liver remnant (FLR) of greater than 20% is not achievable. The goal of preoperative imaging is to identify the number and distribution of liver metastases, in addition to establishing their relation to relevant intrahepatic structures.

Surgical management of retrorectal lesions: what the radiologist needs to know.

OBJECTIVE. The purpose of this article is to highlight the most salient imaging features of retrorectal masses with regard to surgical planning, preoperative biopsy, and identification of nonneoplastic mimickers of malignancy. CONCLUSION.

Gadoxetic acid: pearls and pitfalls.

Gadoxetic acid is a hepatocyte-specific magnetic resonance imaging contrast agent with the ability to detect and characterize focal liver lesions and provide structural and functional information about the hepatobiliary system. Knowledge of the pharmacokinetics of gadoxetic acid is paramount to understanding imaging protocol and lesion appearance and facilitates identification and avoidance of undesired effects with use of this intravenous contrast agent. This article reviews the utility of gadoxetic acid in liver and biliary imaging, with emphasis on the hepatobiliary phase.

CT evaluation of the upper urinary tract in adults younger than 50 years with asymptomatic microscopic hematuria: is IV contrast enhancement needed?

Objective: The purpose of this study is to compare CT urography (CTU) with unenhanced CT in the evaluation of upper urinary tracts in adults younger than 50 years with asymptomatic microscopic hematuria.

Materials And Methods: In this study, 1516 CTU examinations were reviewed in adults younger than 50 years. Inclusion criteria were no significant prior urologic disease and asymptomatic microscopic hematuria with at least one urinalysis with greater than or equal to 3 RBCs/high-power field and less than or equal to 50 RBCs/high-power field.

Mimickers of neoplasm on abdominal and pelvic CT.

Purpose: The radiologist can encounter benign significant imaging findings on computed tomography that can be incorrectly interpreted as neoplasm. The authors review several benign findings and demonstrate several methods to differentiate these findings from more sinister pathology.

Conclusion: It is imperative for the radiologist to be cognizant of and how to correctly identify mimickers of pathology so that unnecessary interventions and surgeries are avoided.

Algorithmic approach to solid adnexal masses and their mimics: utilization of anatomic relationships and imaging features to facilitate diagnosis.

Solid adnexal masses, while less common than their cystic counterparts, may present a challenge for radiologists given the wide range of histologic entities that occur in this region. Pelvic masses, especially when large, can seem overwhelming at first but application of an algorithmic approach allows for more confident assessment. This approach focuses first on the use of anatomic relationships and interactions of various pelvic structures to localize the mass' origin.

Nonvisualization of the ovaries on pelvic ultrasound: does MRI add anything?

Purpose: The purpose of our study is to assess the utility of pelvic magnetic resonance imaging (MRI) in the event that either one or both ovaries are not visualized by pelvic ultrasound.

Materials And Methods: This HIPAA-compliant retrospective study was approved by our local institutional review board and informed consent waived. 1926 pelvic MRI examinations between March 2007 and December 2011 were reviewed and included if a combined transabdominal and endovaginal pelvic ultrasound had been performed in the preceding 6 months with at least one ovary nonvisualized.